Organization
NORTHERN BERKSHIRE SPORTS MEDICINE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL J DONOVAN DO (MEDICAL DIRECTOR)
(413) 663-5450
Entity
Organization
Contact information
Practice address
40 MAIN STREET, SUITE 103, NORTH ADAMS, MA 01247-3416
(413) 663-5450
(413) 664-8737
Mailing address
40 MAIN STREET, SUITE 103, NORTH ADAMS, MA 01247-3416
(413) 663-5450
(413) 664-8737
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
053990
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9773398
—
MA
01
—
M15970
BLUE SHIELD GROUP NUMBER
MA
Enumeration date
12/08/2006
Last updated
08/22/2020
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